ABSTRACT
The average age of dialysis patients is increasing each year, reflecting the aging of the population in general. Hemodialysis [HD] patients suffer from a chronic inflammation. They are at increased risk of cardiovascular disease. To evaluate the persistent elevation of C reactive protein [CRP] as a predictor of cardiac hypertrophy and dysfunction in elderly patients maintained on HD. Quantitative determinations of serum high-sensitivity C reactive protein [hs-CRP] by ELISA were done in the 3 studied groups; Group A: included 30 selected end stage renal disease [ESRD] elderly patients maintained on regular HD at the Main Alexandria University Hospitals. Their mean ages were 68.50 +/- 5.20 years [15 males and 15 females]. Group B: included 20 age-matched elderly healthy individuals. Their mean ages were 69.10 +/- 6.42 years [10 males and 10 females]. Group C: included 10 healthy adult individuals. Their mean ages were 34.20 +/- 4.85 years [5 males and 5females]. Doppler Echocardiography was done to all subjects with estimation of ejection fraction [EF%], fractional shortening [FS%], and left ventricular mass index [LVMi] as well as E/A and El/Al ratios. In elderly HD patients, hs-CRP showed statistically significant higher levels than those of groups B and C with significantly higher values in group B than group C [F=19.85, p=0.001]. By using echocardiography, LVMi showed statistically significant higher values in group A than the other 2 groups with no significant difference between them [F=0.854, p=0.01], whereas FS and EF percentages showed no significant differences between the 3 studied groups. Both E/A and El/Al ratios showed statistically significant lower values in group A than groups B and C [x[2]= 13.33 and 12.38, p= 0.00] and 0.02 respectively]. Correlation study showed a significant negative correlation between serum hs-CRP levels and serum albumin, EF% and E/A ratio. On the other hand, serum hs-CRP levels had a significant positive correlation with serum urea, erythrocyte sedimentation rate [ESR] and LVMi. In elderly patients maintained on HD, the persistent elevation of CRP, which reflects chronic inflammation, had a high impact on the occurrence of left ventricular hypertrophy [LVH] and dysfunction. These data lend support to the hypothesis that inflammation plays an important role in the pathogenesis of cardiovascular diseases in these patients